Bureau of Elderly and Adult Services. Release of Updated Appendix A, Nursing Facility Rates. BEAS Staff; Appendix A Recipients; DCS Supervisors

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1 BEAS /09 N.H. Department of Health & Human Services (DHHS) 129 Pleasant St. Division of Community-Based Care Services (DCBCS) Concord, NH Bureau of Elderly & Adult Services (BEAS) STATE OF NEW HAMPSHIRE BEAS RELEASE OF POLICY PR NUMBER: PR FROM: OFFICE OF: SIGNATURE SIGNATURE : : TO: : Diane Langley, Director, February 19, 2015 Release of Updated Appendix A, Nursing Facility Rates BEAS Staff; Appendix A Recipients; DCS Supervisors January 1, 2015 BACKGROUND/SUMMARY This PR releases the updated Appendix A of the Medicaid Manual, which contains nursing facility rates. In Appendix A of the Medicaid Manual, each nursing facility is listed alphabetically, together with its per diem and monthly rates. These rates are calculated periodically based on information obtained by the Bureau of Elderly and Adult Service s Rate Setting Unit. The NH Department of Health and Human Services computerized eligibility system contains a table with the per diem rates for each nursing facility, and the monthly rate is calculated by multiplying the per diem rate by Appendix A has been updated to include these new rates. Appendix A includes rates for atypical care. An atypical unit and/or facility devotes its services exclusively to highly specialized care, the nature of which makes it incomparable to other nursing facilities for the purpose of rate setting. Where applicable, an asterisk (*) precedes the facility type code as a means of differentiating atypical care rates. The previous Appendix A, which was effective July 1, 2014 and was released by PR, should be retained until further notice. Please post the updated Appendix A according to the instructions below. IMPLEMENTATION The effective dates of the most recent rates are listed for each facility in the updated Appendix A. These rates have already been entered into the Medicaid Management Information System for claims calculation. Questions on this PR should be ed to Jennifer Doig at Page 1 of 2

2 BEAS /09 POSTING INSTRUCTIONS Medicaid Manual Remove and Retain Insert PR Appendix A, PR , pages 1-5, dated 7/14 Appendix A, pages 1-5, dated 1/15 DISTRIBUTION PR is being distributed to certain DHHS staff members, including BEAS staff, as indicated above. DISPOSITION PR may be destroyed once the content has been noted and the posting instructions carried out. Page 2 of 2

3 APPENDIX A 1 MEDICAL ASSISTANCE NURSING FACILITY S PR S Alice Peck Day Memorial Hospital 3/8 $ $3, /1/1999 S Androscoggin Valley Hosp, Berlin 3/8 $ $3, /1/1999 Applewood Care & Rehabilitation Center 3/8 $ $4, /1/2015 Aurora Senior Living of Derry 3/8 $ $4, /1/2015 Bedford Hills Care & Rehabilitation Center 3/8 $ $4, /1/2015 Bel Air - Goffstown 3/8 $ $4, /1/2015 Belknap County, Laconia 2/8 $ $4, /1/2015 S Cheshire Medical Center 3/8 $ $3, /1/1999 Clipper Harbor of Portsmouth Care & Rehab 3/8 $ $4, /1/2015 Colonial Hill of Rochester Care & Rehab 3/8 $ $5, /1/2015 Colonial Poplin 3/8 $ $5, /1/2015 Coos County, Berlin 2 $ $4, /1/2015 Coos County, West Stewartstown 2 $ $4, /1/2015 S Cottage Hospital, Woodsville 3/8 $ $3, /1/1999 Country Village Center 3/8 $ $4, /1/2015 Courville at Manchester 3/8 $ $4, /1/2015 Courville at Nashua 3/8 $ $4, /1/2015 Crestwood Care & Rehabilitation Center 3/8 $ $4, /1/2015 Crotched Mt, HI, Greenfield 8 $ $18, /1/2010 Crotched Mt, Pedi, Greenfield *8 $ $15, /1/2010 Crotched Mt, Vent, Greenfield 8 $ $18, /1/2012 Dover Center for Health and Rehabilitation 3/8 $ $5, /1/2015 Edgewood Manor, Portsmouth 3 $ $4, /1/2015 Edgewood Manor, Portsmouth 8 $ $17, /14/2012 Edgewood Manor, Portsmouth *8 $ $10, /1/2009 Elm Wood Center at Claremont 3/8 $ $4, /1/2015 Epsom HealthCare Center (Heartland), Epsom 3/8 $ $4, /1/2015 Exeter on Hampton Care & Rehab Center 3/8 $ $4, /1/2015

4 APPENDIX A 2 MEDICAL ASSISTANCE NURSING FACILITY S PR Fairview, Hudson 3/8 $ $4, /1/2015 S Franklin Hospital, Franklin, NH 3/8 $ $3, /1/2002 Glencliff Home for the Elderly 4 $ $10, /1/2014 Good Shepherd N.H., Jaffrey 3/8 $ $4, /1/2015 Grafton County, Woodsville 2/8 $ $4, /1/2015 Hackett Hill Healthcare, Manchester 3/8 $ $4, /1/2015 Hanover Hill, Manchester 3/8 $ $4, /1/2015 Hanover Terrace 3/8 $ $4, /1/2015 Harris Hill Center 3/8 $ $4, /1/2015 Havenwood, Concord 3/8 $ $4, /1/2015 Hillsboro House, Hillsboro 3/8 $ $4, /1/2015 Hillsborough County, Goffstown 2/8 $ $4, /1/2015 Hillsborough County, Goffstown *2/*8 $ $6, /1/2009 Holy Cross Health Center 3/8 $ $4, /1/2015 S Huggins Hospital, Wolfeboro 3/8 $ $3, /1/1999 Keene Center 3/8 $ $4, /1/2015 Kindred Transitional Care & Rehabilitation-Braintree 8 $ $12, /1/2013 Kindred Transitional Care & Rehabilitation-Greenbriar 3/8 $ $4, /1/2015 Kindred Transitional Care & Rehabilitation-Greenbriar *8 $ $7, /26/2013 Laconia Rehab Center 3/8 $ $5, /1/2015 Laconia Rehab Center *3 $ $10, /1/2013 Laconia Rehab Center *8 $ $16, /1/2012 Lafayette Center 3/8 $ $4, /1/2015 S Lakes Region General, Laconia 3/8 $ $3, /1/1999 Langdon Place of Dover 3/8 $ $4, /1/2015 Langdon Place of Keene 3/8 $ $4, /1/2015 Laurel Center - Bedford 3/8 $ $4, /1/2015 Lebanon Center 3/8 $ $5, /1/2015

5 APPENDIX A 3 MEDICAL ASSISTANCE NURSING FACILITY S PR S Littleton Hospital, Littleton 3/8 $ $3, /1/1999 Mapleleaf Healthcare, Manchester 3/8 $ $4, /1/2015 Maplewood of Cheshire County,Westmoreland 2/8 $ $4, /1/2015 Maplewood of Cheshire County,Westmoreland *2/*8 $ $6, /1/2009 S Memorial Hospital, North Conway 3/8 $ $3, /1/1999 Merrimack County, Penacook 2/8 $ $4, /1/2015 Merriman House, Memorial Hospital, N Conway 3 $ $4, /1/2015 Metro Health, Goldenview, Meredith 3/8 $ $4, /1/2015 Mineral Springs of N. Conway Care & Rehab 3/8 $ $4, /1/2015 S Monadnock Hospital, Peterborough 3/8 $ $3, /1/1999 Morrison Hospital, Whitefield 3/8 $ $4, /1/2015 Mountain Ridge Center 3/8 $ $4, /1/2015 Mountain View of Carroll County 2/8 $ $4, /1/2015 Mt. Carmel, Manchester 3/8 $ $4, /1/2015 S New London Hospital, New London 3/8 $ $3, /1/1999 NH Hospital - Psych, Concord 7 $1, $40, /1/2011 Oceanside Health & Rehab, Hampton 3/8 $ $4, /1/2015 Pheasantwood Care & Rehabilitation Center 3/8 $ $4, /1/2015 Pleasant Valley Nursing Home 3/8 $ $4, /1/2015 Pleasant View Center 3/8 $ $5, /1/2015 Presidential Oaks -N. H. Odd Fellows, Concord 3/8 $ $5, /1/2015 Ridgewood Center 3/8 $ $5, /1/2015 Riverside of Strafford County, Dover 2/8 $ $4, /1/2015 Riverside of Strafford County, Dover *2/*8 $ $6, /1/2009 Rochester Manor, Rochester 3/8 $ $4, /1/2015 Rockingham County, Epping 2/8 $ $4, /1/2015 Salemhaven Health Care, Salem 3/8 $ $4, /1/2015 S Sceva Speare, Plymouth 3/8 $ $3, /1/1999

6 APPENDIX A 4 MEDICAL ASSISTANCE NURSING FACILITY S PR St. Ann, Dover 3/8 $ $4, /1/2015 St. Francis, Laconia 3/8 $ $4, /1/2015 St. Johnsbury CC, St. Johnsbury, VT 3/8 $ $5, /1/2013 St. Joseph Residence 3/8 $ $4, /1/2015 St. Teresa's, Manchester 3/8 $ $4, /1/2015 St. Vincent de Paul, Berlin 3/8 $ $4, /1/2015 Sullivan County, Claremont 2/8 $ $4, /1/2015 The Elm's Nursing & Rehabilitation Center 3/8 $ $4, /1/2015 S Upper Connecticut Valley, Colebrook 3/8 $ $3, /1/1999 S Valley Regional Hospital, Claremont 3/8 $ $3, /1/1999 Villa Crest, Manchester 3/8 $ $4, /1/2015 W. P. Clough, New London 3/8 $ $4, /1/2015 Warde H.C., Windham 3/8 $ $5, /1/2015 Webster at Rye 3/8 $ $4, /1/2015 S Weeks Hospital, Lancaster 3/8 $ $3, /1/1999 Westwood Care & Rehabilitation Center 3/8 $ $4, /1/2015 Wolfeboro Bay Care & Rehabilitation Center 3/8 $ $4, /1/2015 Woodlawn, Greenleaf, Newport 3/8 $ $4, /1/2015 ICF/MRs: Cedarcrest, Keene 3 $ $11, /1/2009 Cedarcrest, Keene *3 $ $18, /1/2009 Cedarcrest, Keene 8 $ $28, /22/2012 Cedarcrest, Keene *8 $ $24, /22/2012

7 APPENDIX A 5 MEDICAL ASSISTANCE NURSING FACILITY S PR Pursuant to RSA 151-E:11 and He-E , the Department of Health and Human Services, Bureau of Elderly and Adult Services (BEAS) must conduct a cost comparison between the cost of a Choice for Independence (CFI) participant s homebased services and the average annual cost of the provision of services to a person in a nursing facility. This average annual cost for the provision of services to a person in a nursing facility is calculated by the BEAS rate setting unit using the methodology described in Administrative Rule He-E Average Annual Nursing Home Cost for Acuity-Based Facilities 1/1/2015 Annually Monthly Weekly Daily 100% $74,120 $6,177 $1,425 $ % - Signature required $59,296 $4,941 $1,140 $ % $44,472 $3,706 $855 $ % $37,060 $3,088 $713 $ RSA 151-E:11 and He-E state that the commissioner must review and approve any CFI service plan that exceeds 80% of the average nursing facility cost. The commissioner s prior approval process must include a review of the cost of nursing facility services at a nursing facility qualified to provide services, including any specialized services, that would be necessary for the proper care and treatment of the CFI applicant or participant. He-E describes how nursing facilities are reimbursed for specialized or atypical care. Average Annual Nursing Home Cost for Atypical Ventilator Care Facilities 1/1/2015 Annually Monthly Weekly Daily 100% $208,298 $17,358 $4,006 $ % - Signature required $166,639 $13,887 $3,205 $ % $124,979 $10,415 $2,403 $ % $104,149 $8,679 $2,003 $285.34

NH Department of Health & Human Services (DHHS) Office of Finance Concord, NH 03301 STATE OF NEW HAMPSHIRE NH DHHS RELEASE OF POLICY

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